TomTeleRx said:Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the…
Financial impact of cost and coverage weight loss beyond medication cost:
- Groceries: SAVED $286/month (eating less)
- Restaurants: SAVED $196/month (fewer meals out)
- Alcohol: SAVED $146/month (stopped drinking)
- Life insurance: Premium REDUCED by $36/month (lower BMI)
- Copays: SAVED $56/month (fewer BP/cholesterol meds)
Net impact after medication cost: approximately BREAKING EVEN. The medication pays for itself through reduced food spending and healthcare costs. This surprised me.
BiostatsBrad said:Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $286/month (eating less) Restaurants: SAVED $196/month…
BiostatsBrad said:...regarding the discontinuation data for cost and coverage...
I want to reframe the discontinuation narrative. We don't say "insulin fails because blood sugar rises when you stop it." We don't say "antihypertensives fail because BP goes up without them."
Why do we apply different logic to anti-obesity medications? The answer is stigma. We still, unconsciously, believe obesity is about willpower rather than biology. The discontinuation data actually PROVES it's a chronic biological condition requiring ongoing treatment.
This reframing isn't semantic — it has implications for insurance coverage, treatment duration, and patient expectations.
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View ResultsOP back with an update, since a thread like this is useless without one.
Follow-up — getting the denial reason in writing was the step that mattered. It named the criterion, and the criterion was a document I already had.
SleepDoc_PDX said:BiostatsBrad said: ...regarding the discontinuation data for cost and coverage...
Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna after 1 attempts.
What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (PCOS + insulin resistance), and referencing the STEP trial data.
If your PA keeps getting denied, don't give up. Request a peer-to-peer review between your doctor and the insurance medical director. That's what finally broke through for me.